Background: The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C- reactive protein, fibrinogen, and homocysteine to predict risk in non- ST elevation acute coronary s...Background: The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C- reactive protein, fibrinogen, and homocysteine to predict risk in non- ST elevation acute coronary syndromes. Methods: Troponin I, myoglobin, high- sensitivity C- reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non- ST elevation acute coronary syndrome. The risk for major events(death or nonfatal myocardial infarction) at first month and at first year follow- up was analyzed. Results: In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C- reactive protein(P=.007) and myoglobin(P=.02), and at first year troponin I(P=.02), C- reactive protein(P=.03), and homocysteine(P=.04). The rate of major events depending on the number(0- 5) of elevated biomarkers were at first month: 4.1% , 3.7% , 5.7% , 6.1% , 6.5% , and 30.8% (P< .0001), and at first year: 8.2% , 11.1% , 12.3% , 16.2% , 23.7% , and 50% (P< . 0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6[1.3- 1.9] at first month and of 1.4[1.2- 1.7] at first year. Conclusions: Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.展开更多
文摘Background: The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C- reactive protein, fibrinogen, and homocysteine to predict risk in non- ST elevation acute coronary syndromes. Methods: Troponin I, myoglobin, high- sensitivity C- reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non- ST elevation acute coronary syndrome. The risk for major events(death or nonfatal myocardial infarction) at first month and at first year follow- up was analyzed. Results: In a multivariate model adjusting for baseline characteristics and electrocardiographic changes, the only biomarkers related to major events at first month were C- reactive protein(P=.007) and myoglobin(P=.02), and at first year troponin I(P=.02), C- reactive protein(P=.03), and homocysteine(P=.04). The rate of major events depending on the number(0- 5) of elevated biomarkers were at first month: 4.1% , 3.7% , 5.7% , 6.1% , 6.5% , and 30.8% (P< .0001), and at first year: 8.2% , 11.1% , 12.3% , 16.2% , 23.7% , and 50% (P< . 0001). A simple score including the number of elevated biomarkers showed an adjusted risk of major events of 1.6[1.3- 1.9] at first month and of 1.4[1.2- 1.7] at first year. Conclusions: Markers of myocardial damage, inflammation, and homocysteine analyzed separately provide prognostic information. The number of elevated biomarkers is an independent risk predictor of major events.
